Electrical alternans

Electrical alternans as seen by changing QRS amplitudes best seen in lead II

Electrical alternans is an electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats and a possible wandering base-line. It is seen in cardiac tamponade and severe pericardial effusion and is thought to be related to changes in the ventricular electrical axis due to fluid in the pericardium, as the heart essentially wobbles in the fluid filled precardial sac.

Generally electrical alternans can be seen with tamponade, and narrow AV junctional reenterant tachycardia with an accessory pathway (such as WPW syndrome). A similar phenomenon, pseudo-alternans, can be seen in bigeminal PVC in the PR interval, alternans pre-excitation, and alternans bundle branch block. For the most part however, the most serious condition to rule out is tamponade.

See also

• Cardiac tamponade
• Electrocardiogram